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NEWS: GP gatekeeping role “questioned” – but may be crucial for improved cancer care

GPs will continue to play a vital role as a gatekeeper to the NHS and put their patients first despite questions being raised about their role in a new study, senior doctors say today.

The Royal College of GPs, responding to a study published in the latest edition of the British Journal of General Practice, said ‘gatekeeping’ plays a significant role in the triaging of patients in the NHS.

The systematic review of 25 relevant studies in the MEDLINE, PreMEDLINE, Embase, and the Cochrane Library databases found that gatekeeping was associated with better quality of care, lower healthcare use and expenditure and appropriate referral for further hospital visits and investigation.

But one study found that some cancer patients did not benefit from gatekeeping – while some concerns were raised about the accuracy of diagnosis by GPs. There was also evidence of some lower patient satisfaction levels.

The study was conducted by Dr Geva Greenfield, of the department of primary care at Imperial College, London.

Professor Helen Stokes-Lampard, chair of the RCGP, said most of the studies in the report were in the USA.

“Unlike most other healthcare systems around the world, the NHS is free at the point of need and so financial implications do not play any role in the gatekeeping function of UK GPs,” she said.

“While it’s clear to see why UK GPs are often called the ‘gatekeepers of the NHS’, we will always put the needs of the individual patient first and refer anyone who we think might need secondary care intervention.”

She acknowledged the review highlighted a “chronic lack of access to diagnostic tests in primary care”, which can have implications on referral rates for diseases such as cancer.

“GPs take cancer diagnosis extremely seriously, and it’s credit to our colleagues’ hard work that 75% of patients found to have cancer in the UK are referred after only one or two consultations, and that in the last five years the proportion of cancers diagnosed as an emergency dropped from 25% to 20%,” she said.

“Without access to the right diagnostic tests, however, this simply isn’t sustainable and threatens the success of GP gatekeeping schemes across the country. That’s why we desperately need GPs and our teams to have better access to high-quality diagnostic tools in the community, and the appropriate training to use them.”

* GPs will need clear guidance so they can deliver successfully the new Faster Diagnosis Standard for Cancer, researchers say in a second study published in the same journal.

GPs will play a critical role in ensuring the standards are met, say researchers at the University of Surrey.

The new standards are to be introduced in England next year and will give patients a diagnosis or all-clear for cancer within 28 days of referral with suspected cancer.

Patients should have access to “one stop” centres to ensure speedy diagnosis.

The researchers spoke to participants in Bradford and Guildford, all of whom had undergone diagnostic tests for cancer and received results in the previous six months.

Many of the respondents said they were sceptical about how the new standard would work – while others said they were concerned it could become a ‘tick box’ exercise.

They told researchers that they had valued the reassurance and support from their GP and also valued being listened to by their family doctor.

Dr Katriina Whitaker, Reader in Cancer Care at the University of Surrey, said: “The new Faster Diagnosis Standard for Cancer is an important step in diagnosing cancer earlier and faster. However, we have found that although patients value a speedy referral there are other factors that they regard as just as important.

“Simple steps such as informing patients about the diagnostic testing and referral processes and about time scales will help patients better prepare, both physically and emotionally, for the next phase.

“This will ultimately fall to GPs, who will need clear guidance so they are able to support their patients.”

Dr Jodie Moffat from Cancer Research UK, which funded the study, added: “We need to redouble our efforts to reduce the late stage diagnosis of cancer, so that more people survive their disease.

“Reducing late stage diagnosis of cancer requires action on a range of fronts, and we all have a part to play. Ensuring there’s enough workforce in the system – whether that’s in primary care or in hospitals – is vital to achieving our early diagnosis ambitions.”